Medical Care Decisions & Advance Directives WHAT YOU SHOULD KNOW WakeMed Health & Hospitals
What is an advance directive? An advance directive is a set of directions you give about the health/mental health care you would want if you ever lose the ability to make decisions for yourself. North Carolina has three ways for you to make a formal advance directive. Living will Health care power of attorney Advance instruction for mental health treatment What is a living will? In North Carolina, a living will is a document that tells others that you want to die a natural death if you have an incurable or irreversible condition that will result in your death within a relatively short period of time, become unconscious and to a high degree of medical uncertainty, will never regain consciousness or suffer advanced dementia or other substantial loss of cognitive ability that is irreversible. With a living will, you can direct your doctor not to use life-prolonging measures such as mechanical ventilation, dialysis, antibiotics, artificial nutrition and hydration, and similar forms of treatment. Life-prolonging measures do not include comfort measures or palliative care. This document can also give guidance to your family or health care agent if you have a health care power of attorney. What is a health care power of attorney? In North Carolina, you can appoint any adult you trust to make medical/ mental health care decisions for you if you become unable to decide yourself. This person is called your health care agent. In this legal document you name who you want your health care agent to be and describe the care you want. It is important that you discuss with your health care agent what medical treatment/mental health treatments you would want and what you would not want if you become unable to make or express your wishes yourself. Your health care agent then knows what choices you would make.
MEDICAL CARE DECISIONS & ADVANCE DIRECTIVES What is an advance instruction for mental health treatment? In North Carolina, an advance instruction for mental health treatment is a legal document that tells doctors and health care providers what mental health treatments you would want and what treatment you would not want if you later become unable to decide for yourself. The designation of a person to make your mental health care decisions, should you be unable to make them yourself, may be established as part of a valid heath care power of attorney. Who decides about my medical care or treatment? If you are 18 or older and have the capacity to make and communicate health care decisions, you have the right to make decisions about your medical/mental health treatments. You are the only person who can communicate decisions for these documents. These documents cannot be completed for you by any other person. You should talk to your doctor or other health care provider about any treatments or procedures so that you understand what will be done and why. You have the right to say yes or no to treatments recommended by your doctor or mental health provider. If you want to control decisions about your health/mental health care even if you become unable to make or to express them yourself, you will need an advance directive. Do I have to have an advance directive, and what happens if I don t? Making a living will, a health care power of attorney, or an advance instruction for mental health treatment is your choice. If you become unable to make your own decisions and you have no living will, advance instruction for mental health treatment, or a person (health care agent) named to make medical/mental health decisions for you, your health care provider is required to follow the law which provides a listing of the next of kin in order of priority for who the decision maker is.
How do I make an advance directive? You must follow several guidelines when you complete an advance directive. These guidelines are to protect you and ensure that your wishes are clear to the doctor or other providers who may be asked to carry them out. A living will, a health care power of attorney and an advance instruction for mental health treatment must be written and signed by you while you are still able to understand your condition and treatment choices and to make those choices known. Two qualified people must witness all three types of advance directives and each must be notarized. Are there forms I can use to make an advance directive? Yes. There is a living will form, a health care provider power of attorney form and an advance instruction for mental health treatment statutory form that you can use. These forms meet all of the requirements for an advance directive in North Carolina. If you would like copies of these forms, contact our Spiritual Care or Case Management department. When does an advance directive go into effect? A living will goes into effect when you are unable to make decisions, going to die soon and cannot be cured, or when you are unconscious and, to a high degree of medical certainty, will never regain consciousness, or you have advanced dementia or other substantial loss of cognitive ability that, to a high degree of medical certainty, is irreversible. The powers granted by your health care power of attorney go into effect when your doctor states in writing that you are unable to make or to make known your health care choices. The doctor will follow the instructions you have included in your advance instructions for mental health after he or she determines that you are incapable to make and make known your choices about mental health treatment.
MEDICAL CARE DECISIONS & ADVANCE DIRECTIVES What happens if I change my mind? You can cancel your living will at any time, regardless of your physical or mental condition, in writing or in any manner which clearly communicates your intent to revoke. You can cancel your health care power of attorney at any time by executing a new one, reinstating an old one, revoking or changing a new one in writing, or expressing your desire to change your health care power of attorney to your health care agent and doctor. You can change or cancel your advance instruction for mental health treatment as long as you are not incapable to make and communicate your decision to your doctor. With whom should I talk about an advance directive? You should talk to those closest to you about an advance directive and express your feelings about the health care you would like to receive. Your doctor or health care provider can answer medical questions. A lawyer can answer questions about the law. Some people also discuss the decision with clergy or other trusted advisors. WakeMed Spiritual Care and Case Management staff are available to provide additional education and assistance as needed. Where should I keep my advance directive? Keep a copy in a safe place where your family members can access it. You may also want to give copies to your family/significant others, your doctor, other health care providers and your health care agent. You may also file your advance directive with the North Carolina statewide online central registry called Advance Health Care Directive Registry. To do so, go to www.secretary.state.nc.us/ahcdr and click on Directives on File. At the time you register your advance directive online, you will be given a file number and password. Please keep that file number and password handy as your care provider may ask you for it in order to obtain a copy of your advance directive for your medical record. There is a $10 fee for each advance directive that is registered.
Bring your advance directive with you every time you come to the hospital or Emergency Department. Are there other forms that will help ensure my health care decisions are known and followed? Yes. Other forms you may want to be aware of include an Organ Donor card, Portable Do Not Resuscitate (DNR) orders and a Medical Order for Scope of Treatment (MOST) form. Portable Do Not Resuscitate (DNR) orders A Portable DNR order is a medical order that can be followed by emergency medical responders and other health care providers. It tells them not to attempt cardiopulmonary resuscitation if your heart and breathing stops (cardiopulmonary arrest). It is portable; therefore it can be followed in different settings such as your home, a nursing home or a hospital. Because a Portable DNR is a medical order, it must be signed by your physician, physician assistant or nurse practitioner before it can go into effect. It can be cancelled by destroying the document or writing void across the form. For more information, speak with your physician. Organ Donor Card You may indicate your desire to become a donor by checking Yes on your driver s license, carrying a valid donor card, including your wishes in your health care power of attorney and telling your family. You may also document your wishes on the state s Advance Health Care Registry at www.secretary.state.nc.us/ahedr. For more information visit the Carolina Donor Services website: www.carolinadonorservices.org.
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